Field of the Invention
The present invention generally relates to a medical device and method for use thereof for facilitating reduction and repair of a fractured bone. More particularly, the present invention relates to a bone plate for use in osteosynthesis that affords use of at least two surgical approaches for repairing a fractured bone. More specifically, the present invention relates to a bone plate for osteosynthesis that is configured to facilitate utilization of a first surgical approach to attach at least a first portion of the bone plate to a fractured bone, and utilization of a second surgical approach to attach at least a second portion of the bone plate to the fractured bone
Description of the Prior Art
Not all fractures require surgical management, and of those that require surgery, there are a number of options to aid in healing of fractures including, pins, external fixators, intramedullary nails, plate osteosynthesis, etc. However, of these options, a very large number of fractures when treated surgically are in fact managed with plate osteosynthesis.
When approaching a fractured bone, the surgeon decides before surgery on a surgical approach; that is, the surgeon decides on a specific plan of attack for repairing the fractured bone during surgery. To illustrate, the surgeon will decide from an anatomic standpoint the direction that the fracture should be approached, e.g., anterior, posterior, medial, lateral, superior, inferior directions, or, for instance, antero-lateral, postero-lateral directions, etc. In general, the direction of approach to a fractured bone and a specific location along that particular bone has been well described in the anatomical and surgical literature—the direction of approach is not something that is developed de novo for every case. In other words, there are a number of a standard surgical approaches to suit just about all bone fractures. Therefore, a standard surgical approach will be chosen by the surgeon based on the fracture location along the bone. In addition, for the surgical approach decided upon, the surgeon will consider the skin incision and the consequences of making such an incision, the specific soft tissue structures to be encountered and protected during the dissection, and the access to be gained to the fracture itself.
When addressing a clavicle fracture, for example, the surgical approach will depend on the location of the fracture along the bone. To illustrate, for a fracture about the mid-shaft of the clavicle, it is not possible to approach the bone from a posterior direction. An easier approach for such a clavicle fracture may be from a superior direction. However, a problem with the superior approach for a fracture in the proximal end of the clavicle (i.e., closer to the sternum) is that the head and neck are in the way—therefore, access can be limited and it becomes more difficult to use a drill or screw driver or other necessary instrumentation for plate fixation. For a fracture in the proximal end of the clavicle, a surgical approach from a straight anterior direction provides more access. Furthermore, for a more lateral clavicle fracture, a surgical approach from the superior direction may be more suitable and easier to access.
All the bones in the body have such surgical approaches or road maps that allow the surgeon access to a specific fracture location along the bone. In many instances that access is quite limited and the risk of damage of critical nerves and soft tissues structures may be very high. For instance, one such approach is the posterior approach to the shaft of the humerus. The radial nerve is in close proximity to the humerus and in fact it wraps around the humeral shaft along a radial nerve groove. Any traction on the radial nerve usually leads to partial or total nerve injury. Additionally, for instance, making an incision to facilitate positioning of a plate on the antero-medial aspect of the mid-shaft of the tibia can result in wound breakdown and severe complications leading to infection and missing soft tissue coverage of the plate and the bone.
To adapt a conventional long bone plate to a complex fracture scenario, it is usually necessary to bend the plate or contour it to fit the anatomy. Given the typical robustness thereof, bending (or contouring) of conventional long bone plates in a complex fashion can be extremely difficult. Furthermore, helicoid and reconstruction plates are malleable to afford bending (or contouring) thereof in a complex fashion for a complex fracture scenario. However, helicoid and reconstruction plates are usually much weaker than conventional long bone plates, and can fail during axial loads prior to bone healing.
Adaption of plates may require complex three-dimensional synthesis on the part of the surgeon at the time of the surgery, and the time sensitive nature of surgery make it difficult to do so. Moreover, while conventional long bone plates are robust, such plates are difficult to bend (or contour). Furthermore, while helicoid and reconstruction plates are malleable to afford bending (or contouring) thereof, these plates are much weaker than conventional long bone plates.
Therefore, there is a need for a bone plate and a method for use thereof that attenuates the need for such three-dimensional synthesis during surgery, and additionally provides relatively robust structures for attachment to a fractured bone. As discussed below, the bone plate of the present invention can be as robust as conventional long bone plates, but also afford some of the dimensional advantages of helicoid and reconstruction plates. Furthermore, the bone plate and method for use thereof affords use of at least two surgical approaches to attach the bone plate to a fractured bone to facilitate reduction and repair thereof.